Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study

Abstract

Persons with chronic obstructive pulmonary disease (COPD) are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18) with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air) and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy), although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning) and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible.

COPD-Related Anxiety: A Systematic Review of Patient Perspectives

“…Being breathless and running out of oxygen without access to help led to feelings of fear and panic. 19 , 22 , 25 , 38 , 41 , 44 Patients, who had never experienced episodes of severe breathlessness, still felt anxiety and fearful, imagining future episodes of breathlessness. 11 , 30 , 34 , 38 , 49 , 57 Patients were affected by the COPD diagnosis and prognosis and the realization that they had to live with COPD for the rest of their lives.…”

“… 43 The inner processing was described as fear of the process of dying; the long struggle of breathlessness, struggling for air, and painful suffocation. 18 , 19 , 25 , 36 , 41 , 43 , 53 …”

“… 22 When feeling a small change in the quality of breathing or during the first signs of an exacerbation, patients would seek hospital intervention instead of relying on self-management or coping. 33 , 35 , 41 …”

“…11 Patients would often seek hospital intervention instead of relying on self-management or coping. 33 , 35 , 41 Patients were afraid that they would be discharged from the hospital too soon, and they felt safe in the hands of health-care professionals at the hospital. 26 …”

Psycho-Physiological Associates of Dyspnea in Hospitalized Patients with Interstitial Lung Diseases: A Cross-Sectional Study

“…First, obstructive sleep apnea occurs frequently among individuals with ILDs, and it has been found to be significantly correlated with disease severity, including dyspnea symptoms [ 44 ]. Second, it has been reported that difficulty in falling asleep and staying asleep is accompanied by the fear of death and dying due to nighttime dyspnea in patients with COPD [ 45 ]. Cough symptoms at nighttime may compound these upsetting thoughts and, in turn, aggravate a patient’s difficulty in breathing.…”